深刺下关穴配合烧山火治疗风寒型三叉神经痛临床研究

Clinical Study of Deep Needling ST7 Combined with Heat-Producing Needling in Treatment of Trigeminal Neuralgia of Wind-Cold Pattern

目的:观察深刺下关穴配合烧山火治疗风寒型三叉神经痛的临床疗效与机理探讨。方法:选择本院2019年12月—2020年12月收治的风寒型三叉神经痛患者40例随机分为治疗组和对照组,各20例,对照组采用普通针刺,治疗组采用深刺下关穴配合烧山火,比较两组患者临床疗效以及治疗前后简化麦吉尔疼痛问卷评分McGill(VAS评分、疼痛分级指数PRI评分和现有疼痛强度PPI评分)、疼痛发作频次、神经递质含量[血浆P物质(SP)、血浆β-内啡肽(β-EP)、血浆降钙素基因相关肽物质(CGRP)]、红外成像技术和中医症状积分。结果:McGill(VAS评分、PRI评分和PPI评分):治疗后,两组均较治疗前降低,差异具有统计学意义(P<0.01),治疗组优于对照组,差异具有统计学意义(P<0.05);疼痛发作频次:治疗后,两组均较治疗前降低,差异具有统计学意义(P<0.01),治疗组优于对照组,差异具有统计学意义(P<0.05);治疗后,两组血浆β-内啡肽均较治疗前升高,差异具有统计学意义(P<0.01),两组血浆P物质、CGRP含量均较治疗前降低,差异具有统计学意义(P<0.01)且治疗组优于对照组,差异具有统计学意义(P<0.05);红外成像技术:治疗组即刻温度较治疗前明显升高,5 min、10 min、20 min和30 min后温度明显升高,差异有统计学意义(P<0.05或P<0.01),对照组温度差异无统计学意义(P>0.05),治疗后治疗组显然优于对照组,差异具有统计学意义(P<0.05);中医症状积分:治疗后,两组均较治疗前降低,差异具有统计学意义(P<0.01),治疗组优于对照组,差异具有统计学意义(P<0.05)。结论:深刺下关穴配合烧山火手法治疗风寒型三叉神经痛疗效显著,疼痛发作频次减少,疼痛程度明显减轻,总有效率较高。此方法通过降低被致痛物质(P物质、CGRP)的含量、增加其有镇痛作用的神经递质(β-内啡肽)含量从而发挥了强大的镇痛作用。

Objective:To observe the clinical effect of deep needling Xiaguan(ST7)combined with heat-producing needling in the treatment of trigeminal neuralgia of cold pattern.Methods:40 patients with trigeminal neuralgia of cold pattern were randomly divided into the treatment group(n=20)and the control group(n=20).The control group was treated with conventional acupuncture,whereas the treatment group was treated with deep needling ST7 combined with heat-producing needling.The clinical curative effect was compared between the two groups.Also,the scores of VAS,PRI and PPI,the frequency of pain attacks,the contents of SP,β-EP and CGRP,infrared imaging technology parameters and the scores of TCM syndrome integral were compared between before and after the treatment in the two groups.Results:The scores of VAS,PRI and PPI were significantly decreased after the treatment compared to those before the treatment in the two groups(P<0.01);of which the decreases in the treatment group were more significant(P<0.05).The frequency of pain attacks was less after the treatment in both groups(P<0.01);of which the treatment group was superior to the control group(P<0.05).The contents of SP and CGRP were decreased(P<0.01),and the content ofβ-EP was increased after the treatment compared to those before the treatment in the two groups(P<0.01),of which the improvements in the treatment group were more significant(P<0.05).The immediate flesh temperature around ST7 was higher after 5 min,10 min,20 min and 30 min of the treatment than that before the treatment in the treatment group(P<0.05,P<0.01);there were no significant changes in flesh temperature between before and after the treatment in the control group(P>0.05);of which the treatment group was better than the control group(P<0.05).The scores of TCM syndrome integral was lower after the treatment than that before the treatment in the two groups(P<0.01);of which the improvements were more significant in the treatment group(P<0.05).Conclusion:Deep needling ST7 combined with heat-producing needling has a significant effect in the treatment of trigeminal neuralgia of wind-cold pattern,the frequency of pain attacks is decreased and the pain degree is remarkably reduced.The therapy has a higher total effective rate and exerts a significant analgesic effect by reducing the contents of SP and CGRP,as well as by increasing the content ofβ-EP.